The newborns treatment with birth fractures of mixed and long bones

Objective: the work purpose is improvement the quality specialized medical care for newborn with a birth trauma of a skeleton. Materials and methods: surveyed 34 full-term newborns with perinatal damage of the skeleton, which were treated in the department of surgery (Voronezh) for newborns from 3 years. Among them 12 (35 %) children with fractures of the humerus, 2 (6 %) femur fractures, 20 (59 %) with fractures of the clavicle. Used clinical methods are: assessment of the local status, blood pressure and pulse rate, hourly urine output, assessment of pain syndrome pain scale NIPS, laboratory methods (general analysis of blood and urine, acid-base balance), radiation (x-rays, ultrasound of the brain), instrumental (ECG). Results: the main symptoms in long bone fractures are a swelling in the projection of the fracture, limitation of motion; fractures of the clavicle – crepitus, limitation of motion of the upper limb. 19 (56 %) of patients had systolic blood pressure; tachycardia in 25 (74 %), bradycardia in 3 (9 %). The decrease in hourly urine output was noted in one case in a patient with femur fracture (0.8 ml/kg/h). All newborns experienced pain, while 19 (56 %) – severe pain (7-10 on the scale NIPS), 5 (15 %) – moderate pain (4-6 points), 10 (29 %) - mild pain (0-3 points). Distribution leukocytosis – 13 (38 %), metabolic acidosis in 10 (29 %) children. Fractures of the clavicle on radiographs in 14 (41 %) — fracture in the middle third with displacement, 1 (3 %) — bilateral fracture of the clavicle without displacement, 5 (15 %) — fracture of the middle third without displacement; trauma femur 2 (6 %) fracture in the middle third of the right femur with displacement along the length; the trauma of the humerus — 4 (12 %) fracture in the middle third with displacement along the length of, 8 (24 %) — fracture in the middle third without displacement. According to the ECG, the majority noted the shortening of the electrical systole, increasing systolic index. Conclusion: the taped changes from cardiovascular system according to clinical data of the central hemodynamics, an ECG and also indicators of a pain syndrome at newborns with a birth trauma of a skeleton confirm need of an integrated approach to diagnostics and treatment of little patients.

1. Newborns: reducing mortality. // Fact sheet. 2016;333.

2. Vlasyuk VV. Birth trauma and perinatal disorders of cerebral circulation. - SPb., 2009. (in Russ.)

3. Volodin NN, Baybarina EN, Buslaev GN, Degtyarev DN. National leadership “Neonatology”. Moscow; 2009. (in Russ.)

4. Mokrushina OG. Birth trauma. Moscow; 2011. (in Russ.)

5. Isakov YuF, Razumovsky AYu. Pediatric surgery. Moscow; 2015. (in Russ.)

6. Agadzhanyan NA, Smirnov VM. Normal physiology: Textbook for medical students. Moscow; 2009. (in Russ.)

7. Amirov AZh, Kabasawa DJ. Non-invasive methods to diagnose heart diseases in newborns and children of early age. Young scientist. 2015;(21):244-247. (in Russ.)

8. Lilly LS. Pathophysiology of the cardiovascular system. Moscow; 2015. (in Russ.)

9. Assessment and management of pain syndrome in children: a Brief computer training, including who guidelines, 2012 for anesthesia. Moscow; 2014. (in Russ.)

10. Backus AL. Validation of the Neonatal Infant Pain Scale. Masters Th eses, 1996.

11. Prahov AV. Clinical electrocardiography in pediatric practice: a guide for physicians. N. Novgorod; 2009. (in Russ.)

12. Tsaregorodtsev AD, Belozerov YuM, Bregel LV. Cardiology of children’s age. Moscow; 2014. (in Russ.)

13. Shkol’nikova MA. Normative parameters of ECG in children and adolescents. Moscow; 2010. (in Russ.)

14. Klimovitsky VG, Kalinkin OG. Traumatic disease from the standpoint of ideas about system response to injury. Trauma. 2003;4(2):123-130. (in Russ.)

15. Kravchenko EN. Birth trauma: obstetric and perinatal aspects. Moscow;2009. (in Russ.)